Acute leukemia in pregnancy
| . | First trimester . | Outcome . | Second/third trimester . | Outcome . |
|---|---|---|---|---|
| AML: overall outcome | ||||
| N = 898 | n = 20 | CA, n = 3; TOP, n = 1; Normal development, n = 16 (16 y FU) | Second trimester, n = 54 | Live births, n = 46 (IUGR n = 6) FD, n = 8 (IUFD, n = 6; SB, n = 1; TA for CA, n = 1) |
| N = 311 | n = 6 | SA, n = 2; TA, n = 4 | Second trimester, n = 10 | TA, n = 5; SA, n = 1; Live birth, n = 4 (FTND, n = 3; LSCS, n = 1; Prem LCSC, n = 1) |
| Third trimester, n = 15 | Live birth, n = 15 (FT, n = 12; Prem, n = 3) Maternal outcome: toxic death, n = 1; refractory disease, n = 1 | |||
| APL: outcome following ATRA | ||||
| Shapira et al12 | Up to 85% CA | n = 15 | Normal development | |
| Late first trimester, n = 415 | Normal development | |||
| Siu et al13 | — | — | n = 3 | Transient CM, n = 1 Reversible fetal arrhythmia, n = 2 |
| Culligan et al3 | — | n = 1 | LSCS at 30 wk, n = 1 | |
| — | n = 1 (+idarubicin) | Placental abruption and IUFD, n = 1 | ||
| Consoli et al14 | — | — | n = 1 | SVD, Prem, n = 1 (Maternal outcome: postpartum death due to ATRA syndrome) |
| ALL: overall outcome | ||||
| Cardonick8 (N = 60) | n = 38 | No abnormalities, n = 32 | Second trimester, n = 14 | FP, n = 2; IUFD, n = 1; FD, n = 1; CM (transient), n = 1 |
| CA, n = 2; SA, n = 1; Maternal death, n = 1; IUGR, n = 3 | Third trimester, n = 8 | Normal development, n = 8 | ||
| Drugs used in induction-consolidation therapy | ||||
| Cytarabine (alone or in combination) | n = 48,12 | Limb deformities, n = 4 | ||
| n = 898 (all stages of pregnancy) | Cytopenia, n = 5; IUFD, n = 6; IUGR, n = 12; FD due to sepsis, n = 2 | |||
| n = 5210 | Normal delivery, n = 26; IUFD, n = 6; Prem, n = 6; CA, n = 5 IUGR, n = 3; FP, n = 3 | |||
| Anthracyclines | n = 2916 (all stages of pregnancy) | No myocardial damage | ||
| n = 319 | CA, n = 3 | n = 103/n = 26 | CA, n = 2; CM, n = 3 (1 lethal case) | |
| Daunorubicin10 | n = 34 | Normal, n = 15; IUFD, n = 6; Prem, n = 6; CA, n = 2; IUGR = 3; FP, n = 3 | ||
| Idarubicin9 | n = 3 | Reversible CM, n = 2; lethal CM, n = 1 | ||
| Methotrexate | n = 238 | No abnormalities | n = 19 | No abnormalities |
| >10 mg/wk12 | Increased Misc; low birth weight; pancytopenia | Facial and skeletal abnormalities, aminopterin syndrome |
| . | First trimester . | Outcome . | Second/third trimester . | Outcome . |
|---|---|---|---|---|
| AML: overall outcome | ||||
| N = 898 | n = 20 | CA, n = 3; TOP, n = 1; Normal development, n = 16 (16 y FU) | Second trimester, n = 54 | Live births, n = 46 (IUGR n = 6) FD, n = 8 (IUFD, n = 6; SB, n = 1; TA for CA, n = 1) |
| N = 311 | n = 6 | SA, n = 2; TA, n = 4 | Second trimester, n = 10 | TA, n = 5; SA, n = 1; Live birth, n = 4 (FTND, n = 3; LSCS, n = 1; Prem LCSC, n = 1) |
| Third trimester, n = 15 | Live birth, n = 15 (FT, n = 12; Prem, n = 3) Maternal outcome: toxic death, n = 1; refractory disease, n = 1 | |||
| APL: outcome following ATRA | ||||
| Shapira et al12 | Up to 85% CA | n = 15 | Normal development | |
| Late first trimester, n = 415 | Normal development | |||
| Siu et al13 | — | — | n = 3 | Transient CM, n = 1 Reversible fetal arrhythmia, n = 2 |
| Culligan et al3 | — | n = 1 | LSCS at 30 wk, n = 1 | |
| — | n = 1 (+idarubicin) | Placental abruption and IUFD, n = 1 | ||
| Consoli et al14 | — | — | n = 1 | SVD, Prem, n = 1 (Maternal outcome: postpartum death due to ATRA syndrome) |
| ALL: overall outcome | ||||
| Cardonick8 (N = 60) | n = 38 | No abnormalities, n = 32 | Second trimester, n = 14 | FP, n = 2; IUFD, n = 1; FD, n = 1; CM (transient), n = 1 |
| CA, n = 2; SA, n = 1; Maternal death, n = 1; IUGR, n = 3 | Third trimester, n = 8 | Normal development, n = 8 | ||
| Drugs used in induction-consolidation therapy | ||||
| Cytarabine (alone or in combination) | n = 48,12 | Limb deformities, n = 4 | ||
| n = 898 (all stages of pregnancy) | Cytopenia, n = 5; IUFD, n = 6; IUGR, n = 12; FD due to sepsis, n = 2 | |||
| n = 5210 | Normal delivery, n = 26; IUFD, n = 6; Prem, n = 6; CA, n = 5 IUGR, n = 3; FP, n = 3 | |||
| Anthracyclines | n = 2916 (all stages of pregnancy) | No myocardial damage | ||
| n = 319 | CA, n = 3 | n = 103/n = 26 | CA, n = 2; CM, n = 3 (1 lethal case) | |
| Daunorubicin10 | n = 34 | Normal, n = 15; IUFD, n = 6; Prem, n = 6; CA, n = 2; IUGR = 3; FP, n = 3 | ||
| Idarubicin9 | n = 3 | Reversible CM, n = 2; lethal CM, n = 1 | ||
| Methotrexate | n = 238 | No abnormalities | n = 19 | No abnormalities |
| >10 mg/wk12 | Increased Misc; low birth weight; pancytopenia | Facial and skeletal abnormalities, aminopterin syndrome |
—, data not available; ATRA, all-trans-retinoic acid; CA, congenital abnormality; CM, cardiomyopathy; FD, fetal death; FP, fetal pancytopenia; FT, full term; FTND, full-term normal delivery; FU, follow up; IUFD, intrauterine fetal death; IUGR, intrauterine growth retardation; LSCS, lower segment Caesarean section; Misc, miscarriage; Prem, premature birth; SA, spontaneous abortion; SB, stillbirth; SVD, spontaneous vaginal delivery; TA, therapeutic abortion; TOP, termination of pregnancy.